Category: 2021

I almost titled this post, “Contemplating Dying” but I didn’t want to panic anyone! I’m doing fine. I seem to be continuing to recover from my cancer treatments and don’t have any solid reason to expect anything other than continued recovery. I just felt this morning like I wanted to write some more about how to best use my life – particularly now that I’ve realize that our time here is very limited. So yes, the idea of impending death. We all face it someday, and as a society we don’t talk very much about it.

This is a follow-up post to an earlier one this July, when I first I started to really think about the concept that I could actually die relatively soon, rather than in some vague distant future. I still believe that I could die relatively soon (because that’s what the data says), but I’m feeling more settled about it.

The data, by the way, in case you missed that post, says that I have somewhere between 20% – 40% chance of not living for more than 5 years. So let’s say – 30%, but who knows? Logically, if there was anything else in my life that had an approximately 1/3 chance of happening (like pregnancy or a change in job or whatever), I would do some planning for it. I wouldn’t count on it happening because 30% is less than the 70% chance that it doesn’t happen. But I certainly wouldn’t ignore a 30% possibility.

I started talking about the big “what if?”. This caused some consternation among my friends and family, because it’s a hard topic that nobody wants to face. But it’s a very relevant topic to me. My question to myself was, “If I were to die in the next few years, is there anything I would have wished I had done differently?”

There were a few answers to that question that came under the category of “settling one’s affairs.” For example, John agreed to give significant assets to our kids if we knew my death was eminent, rather than waiting until we both die and our estate is settled. I also reached out to various people and said some things that I felt needed to be said – sometimes for my own sake, sometimes for theirs.

Other things had to do with shifting from playing a “long game” to a shorter game. John and I had been diligently preparing for an eventual retirement. But since my diagnosis, we’ve made a series of choices (selling rental properties, walking away from my environmental science career, and purchasing a home in Tucson) that have significantly decreased our ability to rapidly save for retirement. Because of those recent choices, we will not be able to retire as well, or as soon. But we decided the next couple of years were important to us, and we didn’t want to spend them working so hard. We wanted to spend them being together.

In July I started talking about bucket list items. At first, I thought this would be an important way to prepare for the potential end of my life. But then I realized I don’t really have any outstanding bucket list items. I realized it doesn’t really matter to me if I ever see Europe or not. Of course I would like to see Europe before I die, but it’s not like if I go to see Europe, then I would somehow magically be ready to die.

I don’t want to die in my mid-fifties, and it’s not because I did or didn’t get a chance to see Europe. It’s because I want to be there for John and the kids a decade from now, two decades from now, three decades from now. And I can’t rush that. I can’t somehow condense all those times I could help and support my friends and family over the next three decades into a one-year or two-year timeframe. There really isn’t a big thing that I could complete now, and then feel content that I’ve done what I’ve wanted to do. Ta-da! Ready to die! (Not.)

All I really want to do right now is the same things that I want to continue to do for the next three decades. Spend more time with John and the kids. Reach out to my friends and family. Support them in small ways; try to make life a little easier for everyone, including myself.

It’s seems like I should end this post with some sort of awe inspiring, metaphorical photo, but I don’t seem to have one that’s current. Here’s the view out my window this morning.

It’s raining! I guess that explains my mood. In the desert, we welcome the rain, but that doesn’t mean I actually like it! Plus, my ever-practical, house-oriented mind is like, “Huh, the water’s not draining off the patio. It looks like we ought to install a French drain.” By the way, the pool water isn’t actually that blue; that’s the plastic cover we have on it until spring.

Oh look, I found a cactus close-up I took yesterday. Not sure if that’s exactly the metaphorical mood I’m going for. Beautiful but covered in spines? Not a huggable cactus!

I’ll leave you to contemplate cactus spines and I’ll write about something more cheerful next time, I promise!

To send Kristina a comment, email turning51bykristina@gmail.com

For Christmas my brother Steven sent me a book about the history of cancer and cancer treatment. It’s called “The Emperor of all Maladies: a biography of cancer,” by Siddhartha Mukherjee. Steven sent it somewhat hesitantly because, as he warned, “It’s not a light, uplifting read.”

Very true. It’s neither light nor uplifting. It’s a brutal read. But it was absolutely and entirely fascinating; I was completely transfixed. I could barely pay attention to our holiday proceedings (such as they were in a pandemic lockdown) because I was so intent on this book.

It’s not just that I have an obvious interest in the topic. The author is fantastic. Now I want to read everything he has ever written. I like science books, but they can be dry. This one is not dry. I’ve never before been spellbound by the details of drug trial phases (for example).

I’m also going to reread this book. It’s accessible, but dense, and my focus is lacking since my chemo treatments. I would not have been able to make sense of this book during my chemo treatments, and I’ve only barely recovered enough to make some sense of it now.

I’ll warn you though – it’s not pretty. Cancer is a killer. And the treatments throughout history – up until and including now – are only sometimes tolerable. By the way, the term “tolerable”, when used in reference to chemotherapy, doesn’t mean what you would typically think the word means, i.e. “not too bad”. Nope. In this context, “tolerable” means the treatment didn’t kill the patient faster than the cancer was expected to kill them.

The trials were considered successful if it held the cancer at bay for one or two months, even if the patients had catastrophic relapses immediately afterwards. The researchers called the trials “successes” if the drug had any sort of measurable impact, never mind the utter misery of the patients who are being pushed as close to death as absolutely possible, in the wild hope to cure them (or others like them, some many years later, after the drug has been refined).

It’s sad how often researchers have thought they were very close to a cure during this past century, always to find cancer one step ahead. Only very recently have researchers managed to develop a few very effective drugs for a few specific types of cancers.

More generalized, older-style chemotherapies do kill cancer and I’m not recommending against them. Unfortunately chemo can cause enormous collateral damage and it’s too often not a cure. The descriptions of surgeons trying to cure breast cancer with surgery only, before chemo was discovered, were equally brutal. They did not understand how metastatic cancer worked, so they would try to take more and more of the upper body (essentially trying to “get it all”), but in the case of metastatic cancer (stage 4), it would never work. You cannot cure metastatic cancer with surgery alone.

However, as horrifying as that all was, I found the book to be more interesting than depressing. And the detailed knowledge the researchers are gaining just this past decade is encouraging. It’s clear that for the drugs to be truly effective, they’re going to have to be very, very specific to the type of cancer and the genetics of the individual patients. That’s a huge task, and it’s a long road ahead, but it’s a path forward.

To send Kristina a comment, email turning51bykristina@gmail.com

My brother Steven sent me an email this morning, which I’m reposting with his permission. Steven lives with his family in Ann Arbor, Michigan. Here’s what Steven wrote:

There’s a middle-aged homeless man named Jim who hangs out on a busy street corner a half dozen blocks from our house.  I pass him when I bike or walk to work, and he’s been there since early summer or so, so I’ve gotten to know him a bit.  He’s friendly and very polite and seems like a nice guy all around.  One of the first things I noticed about him was how neat and clean he kept his area, always making sure that his trash was picked up and his few possessions were tidily arranged, and how he always made sure not to be in my way when I was coming through on my bike.  Overall he seems very thoughtful and responsible.  

He spends his time panhandling for change or temp work to buy food, coffee and cigarettes. Some nights he would sleep there on the corner in a sleeping bag, although other nights he seemed to be elsewhere (when I asked him once he indicated that a gas station down the street let him sleep on their property.  He may also have other places; certainly I don’t know everything about his life).  As the weather turned rainier in the fall I gave him an old tent we weren’t using to help him stay out of the rain.  I haven’t seen him use it (maybe it’s at his place by the gas station where he has more room?) but he was quite appreciative and became chattier after that.

One day in the early winter as I stopped by and chatted waiting for the light to change he mentioned he had been in the hospital and showed me where his hands had been badly burned during an accident when he was doing an odd job for someone.  How unfortunate, to have to be discharged from the hospital onto a street corner! But he seemed reasonably chipper about it – his hands were healing.  He was even more excited a week or two later to tell me that he had just that day signed some papers and he was supposed to be in an apartment come Dec. 7th – something through the help of the local government or charity, I presume.  I was also quite relieved to hear that, and excited for him.

Unfortunately, mid December I saw him out on the corner again.  He said there had been some sort of delay, and now they weren’t going to have the apartment ready for him until the end of January.  That’s a big difference when it comes to winter around here.  He also told me that day that he was going to be in the hospital again – he was going to have surgery for  advanced stage lung cancer.  Now, maybe this wasn’t a big surprise considering that he had two unlit cigarettes in his mouth as he was telling me this (though he was quick to point out that it ran in the family), but still – homeless and dying of cancer!

In a few weeks his surgery date came and I didn’t see him for a little while, until yesterday when he flagged me down on my bike a block or so away from his corner.  I asked about the surgery and yes, he had had it – showed me with his hands how much of his lung they had removed, and said they got 85% of the cancer. Now he’s on chemo for a few more weeks, and then it will be radiation, and then maybe more chemo, depending.  In the meantime, he’s still homeless, still waiting for that late January apartment.  I asked about side effects of the chemo, and he said they were bad – tired all the time, and sometimes throwing up.  I asked him if he needed anything, and he said as long as he could afford coffee to keep himself warm he was doing fine, so I gave him a 20 and told him I’d pray.

I’ve been thinking about him a lot, even before this last encounter.  I’m sad for him, but also amazed at his resilience and how he manages to have a pretty chipper attitude and just keep on going even through all of this.  I’m also just wondering at the crazy stupidity of a system that treats people for cancer and then discharges them onto the street corner.  Admittedly, he is clearly getting some help and services; one day I saw him loading his few belongings up into a van with some government logo, and of course there is the promise of an apartment, and the medical treatment itself.  But how is it that we as a society can afford an expensive surgery and chemo for him, yet not be able to find a place for him to stay while he recovers?  I don’t know all of his story, and I know from other situations that sometimes the homeless don’t make it easy for themselves to get lasting help or a stable situation.  But he seems to be of right mind, and easygoing and so responsible it’s hard for me to imagine what the hangup would be.

I also don’t know what I can do for him other than being friendly and giving a little change now and then.  Maybe that’s all he needs from me; that’s all he asks for when I inquire.  He does seem to have a warm coat and winter gear.  But I don’t know.  It all seems so crazy to me, and I’ve been thinking about it a lot.

To send Kristina a comment, email turning51bykristina@gmail.com